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Cancer Free but Hormones a Mess

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  • Cancer Free but Hormones a Mess

    Iím 25 years old. I was diagnosed with Testicular Cancer on October 31, 2017. I had a right radical orchiectomy two days later. My cancer was found in the very early stages and I didn't require any further treatment. In January my oncologist told me I was currently cancer free and we would go into surveillance mode moving forward.

    The following symptoms first began sometime around late 2014 or early 2015. I dont smoke or drink. I lift weights 3-4 times per week and I try to eat as healthy as possible. I should be healthy.

    I constantly feel tired/fatigued and feverish throughout the day (hot flashes?). I have lost my motivation/drive and have been dealing with bouts of depression. I suffer from anxiety and have trouble sleeping. Although I am extremely dedicated to lifting weights and tracking what I eat I canít put on muscle or lose fat effectively. My sex drive is really low. I can get an erection but it doesnít get as hard as before. I donít really have spontaneous or morning erections any more.

    Most would describe me as very lean but I actually carry a lot of extra body fat. I have always carried extra fat around my chest and nipples. The rest of my body fat is all centered around my waist (love handles), hips and thighs.

    I dont think the cancer was responsible for most of these symptoms because it was discovered in the very early stages and Iíve had these symptoms for years. I'm not sure how much of my following bloodwork was influenced by the cancer.

    Here are my Labs from when I went to see an endocrinologist after I had surgery.

    Taken 12/8/2017 at 10 am fasted @ Quest

    TSH: .86 ( .40 - 4.5 mIU/L)
    T4, free: 1.2 ( .8 - 1.8 ng/dL)
    ACTH, PLASMA: 17 ( 6 - 50 pg/mL)
    DHEA SULFATE: 210 ( 85 - 690 mcg/dL)
    FSH: 14.6 ( 1.6 - 8 mIU/mL) HIGH
    LH: 13.9 ( 1.5 - 9.3 mIU/mL) HIGH
    ESTRADIOL: 55 ( < OR = 39 pg/mL) HIGH
    Testosterone, TOTAL, LC/MS/MS: 679 ( 250 - 1100 ng/dL)
    Free Testosterone(DIALYSIS): 69.9 ( 35 - 155 pg/mL)
    CORTISOL 8 AM: 13.4 ( 4 - 22 mcg/dL)

    After these results I changed my diet to try and lower my estradiol and might as well try to raise TT also. I started taking Vit D, Zinc, Magnesium, and Dim. I started eating more dietary fat and ate a few natural foods that should help lower estrogen like grapes, oranges, pomegranate juice and broccoli/cauliflower.

    At my follow up appointment I was scheduled more bloodwork.

    Taken 2/14/2018 at 12pm unfasted @ Quest

    FSH: 29.8 ( 1.6 - 8 mIU/mL) HIGH
    LH: 22.9 ( 1.5 - 9.3 mIU/mL) HIGH
    ESTRADIOL: 50 ( < or = 39 pg/mL) HIGH
    SHBG: 96 ( 10 - 50 nmol/L) HIGH
    Testosterone, TOTAL, TC/MS/MS: 854 ( 250 - 1100 ng/dL)
    Free Testosterone (DIALYSIS): 54.5 ( 35 - 155 pg/mL)

    As you can see TT did go up a lot and Estradiol did decrease slightly. Sbhg is way too high and FSH and LH continue to rise.

    I was hoping I could get an idea of what is going on with my body. I want some advice on all my possible treatment options or courses of action going forward before I go see my endocrinologist again in March.

  • #2
    You are NOT alone. Many men post TC have hormonal issues. I heard an Endocrinologist speak at a TC Summit last October, basically, if you are having symptoms that last past 12 months than the numbers do not matter so much. What you do need to consider if you pursue treatment is the impact on fertility at your age. There is Testosterone replacement or Clomid to use for treatment. If you would like the doctor's name who spoke at the TC Summit in Denver, CO let me know.
    Son Grant
    dx 12/21/16 at age 17

    BEP x3
    Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
    2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
    Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.


    • #3

      Only my opinion based on my personal experiences.

      I too had some hormonal issues after orchiectomy and chemotherapy. My testosterone was much lower though at 250 ng/dL. From what I understand <300 ng/dL AND associated symptoms you describe is typically treated with testosterone replacement therapy (TRT). An alternative is an oral medication (selective estrogen receptor modulator) called Clomid. Although your testosterone level is relatively high, it may be below normal for you. What I understand for estradiol/testosterone is that the ratio of test/estradiol should be < 10, which you have.

      The symptoms you describe seem to coincide with what I observe with low testosterone.

      In general, I would suggest to you to describe these symptoms to your doctor with as much specificity and details as possible. In general, treatment is not generally pursued unless you express that it's impacting your life significantly. Also, a urologist (or sometimes fertility urologist) may have more experience with these issues than your endocrinologist. Make sure to ask their experience with testis cancer and low-testosterone.

      Also, you may be too close to orchiectomy to really see the steady-state effects of having only one testicle. It may take some more months to adjust.
      Age 31 - Portland, OR
      01NOV16- Pain in right testicle, palpable mass
      13NOV16- R I/O. Markers normal
      27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
      06DEC16 - CT scan clear
      09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
      03JAN17- Ended 1xBEP; start surveillance
      18MAR17-2nd pathology report shows 90% EC , 10% seminoma